Provider Demographics
NPI:1598540155
Name:PREMIER LOWER LIMB CLINIC CORP
Entity Type:Organization
Organization Name:PREMIER LOWER LIMB CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKATTAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-707-1378
Mailing Address - Street 1:645 NEWARK AVE # O8242
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2303
Mailing Address - Country:US
Mailing Address - Phone:201-707-1378
Mailing Address - Fax:
Practice Address - Street 1:101 EISENHOWER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1054
Practice Address - Country:US
Practice Address - Phone:201-707-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty